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From the 5/7/2021 release of VAERS data:

This is VAERS ID 864321



Case Details

VAERS ID: 864321 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Colorado  
Vaccinated:2019-11-16
Onset:2019-11-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-03-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR UJ293AA / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute cardiac event, Asthenia, Dehydration, Diarrhoea, Gastrointestinal disorder, Nausea, Sudden death, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Noninfectious diarrhoea (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2019-11-19
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acidophilus, famotidine, potassium chloride ER, quetiapine, Ativan, tums
Current Illness: Was hospitalized for acute urinary retention, low grade fever with initial suspicion for pneumonia that was subsequently ruled out. Patient was discharged on 11/18/2019. During the hospital stay she had an influenza vaccine administered, Fluzone high dose lot #UJ293AA on 11/16/2019. She developed nausea, vomiting and diarrhea that her physician, MD was concerned could be related to the vaccine. The patient died suddenly at her assisted living facility while on the toilet on 11/19/2019. This was thought to be an acute cardiac event, possibly an arrhythmia related to dehydration she sustained due to the gastrointestinal symptoms she was experiencing.
Preexisting Conditions: hypertensive heart disease, cardiomegaly, GERD, anxiety, dementia, iron deficiency anemia
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Nausea, vomiting and diarrhea 48-72 hours after administration of the vaccine. Unknown whether this was the result of the vaccination or something else. The patient was frail, had underlying heart conditions and died of a cardiac event which likely was related to dehydration sustained from these symptoms.


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